The role of symptom accommodation in trauma-focused treatment engagement and response

Kristen P. Howard; Michele R. Spoont; Melissa A. Polusny; Afsoon Eftekhari; Craig S. Rosen; Laura A. Meis

doi:10.1002/jts.22912

The role of symptom accommodation in trauma-focused treatment engagement and response

Kristen P. Howard, Michele R. Spoont, Melissa A. Polusny, Afsoon Eftekhari, Craig S. Rosen, Laura A. Meis

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Although trauma-focused treatments (TFTs) are generally effective, not all patients improve. Symptom accommodation (i.e., altering one's behavior in response to another's symptoms) by loved ones may be particularly relevant to TFT treatment response and engagement. We examined the role of symptom accommodation by support persons (SPs) in veterans’ PTSD treatment response, including the mediating role of treatment engagement and the moderating role of relationship strain. Veterans engaging in prolonged exposure or cognitive processing therapy and a loved one (N = 172 dyads) were sampled at two time points approximately four months apart. Measures of treatment engagement (i.e., highest session completed from the treatment protocol and homework completion) were obtained from hospital records. We found that relationship strain moderated the effect of symptom accommodation on treatment response, ∆R² =.02. Specifically, Time 1 (T1) accommodation predicted poorer treatment response (i.e., Time 2 [T2] PTSD symptom severity, controlling for T1 symptoms) among veterans who reported below-average relationship strain only. Additionally, symptom accommodation was indirectly related to treatment response such that T1 accommodation predicted higher T2 PTSD symptom severity specifically through reduced homework completion, β =.01. The findings suggest that attending to accommodating behaviors of veterans’ supportive partners may be an important way to boost both engagement in and response to TFTs for PTSD.

Original language	English (US)
Pages (from-to)	524-536
Number of pages	13
Journal	Journal of Traumatic Stress
Volume	36
Issue number	3
DOIs	https://doi.org/10.1002/jts.22912
State	Published - Jun 2023

Bibliographical note

Funding Information:
This research was supported by grants from the U.S. Department of Defense's Congressionally Directed Medical Research Program (W81XWH‐12‐1‐0619) and the Department of Veterans Affairs (HSR&D CDA 10–035; RRP 12–229). This material is the result of work supported with resources and the use of facilities at the Center for Care Delivery & Outcomes Research and the Minneapolis Veterans Affairs Health Care System. The findings and conclusions in this document are those of the authors and do not represent the views of the Department of Veterans Affairs or the United States government. No investigators have affiliations or financial involvement that conflict with the material presented.

Publisher Copyright:
Published 2023. This article is a U.S. Government work and is in the public domain in the USA.

PubMed: MeSH publication types

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

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title = "The role of symptom accommodation in trauma-focused treatment engagement and response",

abstract = "Although trauma-focused treatments (TFTs) are generally effective, not all patients improve. Symptom accommodation (i.e., altering one's behavior in response to another's symptoms) by loved ones may be particularly relevant to TFT treatment response and engagement. We examined the role of symptom accommodation by support persons (SPs) in veterans{\textquoteright} PTSD treatment response, including the mediating role of treatment engagement and the moderating role of relationship strain. Veterans engaging in prolonged exposure or cognitive processing therapy and a loved one (N = 172 dyads) were sampled at two time points approximately four months apart. Measures of treatment engagement (i.e., highest session completed from the treatment protocol and homework completion) were obtained from hospital records. We found that relationship strain moderated the effect of symptom accommodation on treatment response, ∆R2 =.02. Specifically, Time 1 (T1) accommodation predicted poorer treatment response (i.e., Time 2 [T2] PTSD symptom severity, controlling for T1 symptoms) among veterans who reported below-average relationship strain only. Additionally, symptom accommodation was indirectly related to treatment response such that T1 accommodation predicted higher T2 PTSD symptom severity specifically through reduced homework completion, β =.01. The findings suggest that attending to accommodating behaviors of veterans{\textquoteright} supportive partners may be an important way to boost both engagement in and response to TFTs for PTSD.",

author = "Howard, {Kristen P.} and Spoont, {Michele R.} and Polusny, {Melissa A.} and Afsoon Eftekhari and Rosen, {Craig S.} and Meis, {Laura A.}",

note = "Funding Information: This research was supported by grants from the U.S. Department of Defense's Congressionally Directed Medical Research Program (W81XWH‐12‐1‐0619) and the Department of Veterans Affairs (HSR&D CDA 10–035; RRP 12–229). This material is the result of work supported with resources and the use of facilities at the Center for Care Delivery & Outcomes Research and the Minneapolis Veterans Affairs Health Care System. The findings and conclusions in this document are those of the authors and do not represent the views of the Department of Veterans Affairs or the United States government. No investigators have affiliations or financial involvement that conflict with the material presented. Publisher Copyright: Published 2023. This article is a U.S. Government work and is in the public domain in the USA.",

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AU - Eftekhari, Afsoon

AU - Rosen, Craig S.

AU - Meis, Laura A.

N1 - Funding Information: This research was supported by grants from the U.S. Department of Defense's Congressionally Directed Medical Research Program (W81XWH‐12‐1‐0619) and the Department of Veterans Affairs (HSR&D CDA 10–035; RRP 12–229). This material is the result of work supported with resources and the use of facilities at the Center for Care Delivery & Outcomes Research and the Minneapolis Veterans Affairs Health Care System. The findings and conclusions in this document are those of the authors and do not represent the views of the Department of Veterans Affairs or the United States government. No investigators have affiliations or financial involvement that conflict with the material presented. Publisher Copyright: Published 2023. This article is a U.S. Government work and is in the public domain in the USA.

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N2 - Although trauma-focused treatments (TFTs) are generally effective, not all patients improve. Symptom accommodation (i.e., altering one's behavior in response to another's symptoms) by loved ones may be particularly relevant to TFT treatment response and engagement. We examined the role of symptom accommodation by support persons (SPs) in veterans’ PTSD treatment response, including the mediating role of treatment engagement and the moderating role of relationship strain. Veterans engaging in prolonged exposure or cognitive processing therapy and a loved one (N = 172 dyads) were sampled at two time points approximately four months apart. Measures of treatment engagement (i.e., highest session completed from the treatment protocol and homework completion) were obtained from hospital records. We found that relationship strain moderated the effect of symptom accommodation on treatment response, ∆R2 =.02. Specifically, Time 1 (T1) accommodation predicted poorer treatment response (i.e., Time 2 [T2] PTSD symptom severity, controlling for T1 symptoms) among veterans who reported below-average relationship strain only. Additionally, symptom accommodation was indirectly related to treatment response such that T1 accommodation predicted higher T2 PTSD symptom severity specifically through reduced homework completion, β =.01. The findings suggest that attending to accommodating behaviors of veterans’ supportive partners may be an important way to boost both engagement in and response to TFTs for PTSD.

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The role of symptom accommodation in trauma-focused treatment engagement and response

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